K Number
K974178
Device Name
PASSPORT 5L-CE MODEL 0998-00-0131XXX
Manufacturer
Date Cleared
1998-06-26

(232 days)

Product Code
Regulation Number
870.2300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The indications for use for the Passport 5L-CE Monitor include the monitoring of the following human physiological vital signs: - Blood Oxygenation (SpO2) measurement/waveform - ECG waveform derived from 3 or 5 Lead measurements - Respiration rate/waveform derived from ECG or CO2 - Temperature measurement via YSI 400/700 series probes - Invasive Blood Pressure (IBP) measurement/waveform measurable at two sites - Non Invasive Blood Pressure (NIBP) measurement - CO2, Inspired and end tidal mainstream/waveform - Heart Rate derived from selected source ((SpO2, ECG, IBP, NIBP)
Device Description
Passport 5L-CE Vital Signs Monitor
More Information

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Not Found

No
The document describes a standard vital signs monitor and does not mention any AI or ML capabilities.

No
The device is a vital signs monitor used for measuring and displaying physiological data, not for treating a disease or condition.

No

The device is described as a "Vital Signs Monitor" and its intended use is for "monitoring" various physiological vital signs. While monitoring provides data relevant to diagnosis, the device itself is not stated to perform diagnosis or provide diagnostic interpretations.

No

The device description explicitly states "Passport 5L-CE Vital Signs Monitor," which is a hardware device designed to monitor multiple physiological vital signs using various probes and measurement techniques (SpO2, ECG, Respiration, Temperature, IBP, NIBP, CO2). This indicates it is a hardware-based medical device, not software-only.

Based on the provided information, the Passport 5L-CE Monitor is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Passport 5L-CE Monitor Function: The description clearly states that the Passport 5L-CE Monitor measures physiological vital signs directly from the human body. These are non-invasive or minimally invasive measurements taken in vivo (within the living organism), not in vitro (in a test tube or laboratory setting).

The measurements listed (SpO2, ECG, Respiration, Temperature, IBP, NIBP, CO2, Heart Rate) are all direct physiological measurements, not tests performed on samples outside the body.

N/A

Intended Use / Indications for Use

The indications for use for the Passport 5L-CE Monitor include the monitoring of the following human physiological vital signs:

  • SpO2 Blood Oxygenation measurement/waveform
  • ECG waveform derived from 3 or 5 Lead measurements
  • Respiration rate/waveform derived from ECG or CO2
  • Temperature measurement via YSI 400/700 series probes
  • Invasive Blood Pressure (IBP) measurement/waveform measurable at two sites
  • Non Invasive Blood Pressure (NIBP) measurement
  • CO2, Inspired and end tidal mainstream/waveform
  • Heart Rate derived from selected source (SpO2, ECG, IBP, NIBP)

Product codes

DRT

Device Description

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Mentions image processing

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Mentions AI, DNN, or ML

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Input Imaging Modality

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Anatomical Site

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Indicated Patient Age Range

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Intended User / Care Setting

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Description of the training set, sample size, data source, and annotation protocol

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Description of the test set, sample size, data source, and annotation protocol

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Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

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Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

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Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

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Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

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Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

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§ 870.2300 Cardiac monitor (including cardiotachometer and rate alarm).

(a)
Identification. A cardiac monitor (including cardiotachometer and rate alarm) is a device used to measure the heart rate from an analog signal produced by an electrocardiograph, vectorcardiograph, or blood pressure monitor. This device may sound an alarm when the heart rate falls outside preset upper and lower limits.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized symbol that resembles a person's face in profile, with three overlapping heads.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN 26 1998

Mr. Russell Olsen Director, Product Assurance and Quality Engineering Datascope Corporation Patient Monitoring Division 580 Winters Avenue Paramus, NJ 07652

K974178 Re: Passport 5L-CE Vital Signs Monitor Regulatory Class: II (two) Product Code: DRT Dated: April 3, 1998 Received: April 6, 1998

Dear Mr. Olsen:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (QS) for Medical Devices: General requlation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in requlatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act

1

for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4648. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours,
Thomas J. Callahan

Thomas J. Callahan, Ph.D. Director Division of Cardiovascular, Respiratory, and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Page I of I

510(k) Number (if known): K974178

Device Name: Passport 5L-CE

Indications For Use:

The indications for use for the Passport 5L-CE Monitor include the monitoring of the following human physiological vital signs:

  • 0 Blood Oxygenation (SpO2) measurement/waveform
  • ECG waveform derived from 3 or 5 Lead measurements 0
  • O Respiration rate/waveform derived from ECG or CO2
  • Temperature measurement via YSI 400/700 series probes ೦
  • o Invasive Blood Pressure (IBP) measurement/waveform measurable at two sites
  • 0 Non Invasive Blood Pressure (NIBP) measurement
  • o CO2, Inspired and end tidal mainstream/waveform
  • Heart Rate derived from selected source ((SpO2, ECG, IBP, NIBP) o

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use XX (Per 21 CFR 801.109) OR

Over-The-Counter Use__

(Optional Format 1-2-96)

V. Miller

(Division Sign-Off)
Division of Cardiovascular, Respiratory,
and Neurological Devices
510(k) Number K974178